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Thread: seeking advice

  1. #1
    Join Date
    Aug 2008
    Posts
    2

    Default seeking advice

    Hello Julie & Drusilla,
    My WA Rehabilitative Certification and Common Movement Disorders Certifications prepared me to meet many challenges. This past Monday brought something entirely new - an older gentlemen (retired) with a prosthesis for the lower left leg and foot. His leg was amputated immediatey above the knee joint (30 years ago!) His family physician recently ordered him to get involved in an exercise program as a means of losing weight. He heard good things about my WaterART class and decided to give it a try. Tom was able to use the pool stairs to enter the pool (pool ladder too difficult). The prostethic foot was immediately problematic on the slick pool floor. I assisted him to the side of the pool and suggested he stay within reach of the pool wall. I stayed close by. He slipped and floundered only once. He needed assistance to recover. He was able to perform some of the basic movements like walking in place, cycling while holding onto the pool wall, skateboard while holding on to the pool wall etc. Most of his inability to perform many exercises stems from the fact that his body is constantly unbalanced as a result of the missing limb, the prosthetic foot has zero pronation/supination action and only marginal dorsiflexion/plantar flexion. His knee ROM is very good but the artificial foot is oddly buoyant. He has metal from knee to foot.

    He isn't strong enough to recover from a fall in the water - zero abdominal strength, and it's going to be difficult to build ab strength without the counterbalancing weight of the missing leg. He is very overweight - which also compromises his balance in the water. His best assets are: a terrific sense of humor and willingness to try absolutely anything, very strong quads on the right side, good biceps/triceps and shoulder strength from pushing his wheelchair; needs to really stretch all chest muscles and work on all his back muscles. Posture is compromised (hunched), head is forward. Hope that gives you enough to work on. I'm looking for any suggestions that would compensate the overly buoyant foot and posture imbalances caused by the amputation. He is also diabetic and believes that he will lose his other leg sooner or later. I would like to do everything I can for him. Obviously good pool shoes would be helpful.

    I welcome your suggestions. Many thanks, Valerie

  2. #2
    Join Date
    Aug 2008
    Location
    Toronto & willing to travel the world
    Posts
    203

    Default Having more ideas and being patient

    Valerie,

    My experience is that they take their prosthesis off. Did his doctor recommend he keep it on?

    also - I would put him in the deep ( with a belt) simply because most men balance at their chest and it may be easier to balance and he certainly can do some exercises with one let

    Maybe over time, he can progress to the noodle - try different belts and noodles ( in terms of buoyancy and density of the buoyancy as they may "balance " very differently with several types of equipment.

    sounds like he is comfortable in the water -so that is a great thing.

    Julie
    Creator & Top Motivator!!
    http://www.waterart.org
    info@waterart.org

  3. #3
    Join Date
    Aug 2008
    Location
    Egmondville- ON, Big Canoe-GA, Bonita Springs-FL
    Posts
    23

    Default Hi Valerie - I agree with Julie

    If he is showing up for a shallow water class but the pool, extends into a deep section this man would be best working out in deep water using a belt - without the prosthesis (unless her refuses to take it off.) This will enable him to use the one good leg and the part leg without having to worry about slipping and trying to balance on the pool floor or you trying to save him from a slip.

    He sounds like he likes water so it could be a win- win situation if you can go over some of the moves with him one-one to show him how to use a belt.
    If he comes to the shallow class he can work close to the deepest edge of the shallow class and do as many of the moves as possible
    - and if he can't let him do something east that he likes.
    If you have a deep class suggest he comes to that if possible
    - however regardless of which class he comes to you have to point out that he must work within the limits of his ability (i.e. starting at A and work through B- C etc and not jumping down to M before he is ready)
    - skill will come the more he is able to attend.

    Using a belt he will be suspended:
    What you need to do first is to teach him is how to right himself in case he falls forward or backwards with the belt on due to leg length imbalance and poor abdominal strength
    - to do this
    If forward on his face -(emergency!) MOST IMPORTANT - teach him to roll over on to his back to get his face out of the water
    - then pull the leg and partial leg into a tuck position (use arms to pull into the belly button) and press the legs down to vertical -
    If he is already on his back (he will be floating so can breathe OK ) he will need to do the same without the roll over
    I would teach him this as soon as possible as this is great abdominal strengthening work which is required for deep/belt water work.

    In the deep water he can do all the leg moves - bicycle, XC, Jogging etc. using one leg and the other as much as possible. Thus will help with the circulation on the good leg - something he needs to maintain to keep it healthy - with moves such as JAX or side moves he will have to learn to balance (more abdominal work), Preferably he will learn how to use his arms effectively for these moves BUT
    If he can't stay vertical in the deep you could give him a noodle to push in front of him - as a moving wall - but once he can balance take it away as it will become a crutch.

    - I am sure he needs a lot of upper body postural training -
    He can do a lot of upper body strengthening using seated, or vertical positions to take the legs out of the equation - you can introduce resistive equipment once he "Gets" the correct joint/muscle movement.
    Upper body strength will help him move more successfully when he does cardio incorporating both upper and lower limbs. (Burn more calories)
    This will get him fitter which hopefully help him control his diabetes.
    If he can stick to it he will become successful as time goes along.

    With diabetes I would encourage him to wear a shoe on his good leg even though he would be suspended,
    Remind him how important it is to protect his good foot - The shoe will protect from any scrapes, bumps and bruises that he might not even notice but could develop into something more serious - a shoe is hygienic protection from plantars warts, athletes foot etc. - and will cause slightly more resistance to make him work harder.

    With a diabetic remind him that doing an exercise program requires that he takes his insulin at the proper time - he should preferably eat something before coming to class - should bring a drink to the side of the pool - . (and maybe orange or apple juice in case he needs it - it is useless left in a locker back in the dressing room).
    Make sure he works facing you - Keep watch on his face and talk from time to time.

    I have had a diabetic lady start going into a coma in the pool - she was floating away and her face looked like "nobody was home" when I spoke to her. We corralled her with noodles and floated her to the chair lift to get her out.

    Hope these ideas help a bit
    Good luck and keep up the great work you are doing for the people in your area.


    Drusilla Leitch, Certification Director
    WaterART Fitness International Inc.

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